Provider Demographics
NPI:1508105008
Name:COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC
Other - Org Name:COMMUNITY HEALTH CENTERS NEW CUYAMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-361-8014
Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8014
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:4711 HIGHWAY 166
Practice Address - Street 2:
Practice Address - City:NEW CUYAMA
Practice Address - State:CA
Practice Address - Zip Code:93254-0000
Practice Address - Country:US
Practice Address - Phone:661-766-2149
Practice Address - Fax:661-766-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1508105008Medicaid